On the morning of 6 August 1945, Yamaguchi, a shipbuilder for Mitsubishi Heavy Industries in Nagasaki, suffered severe burns while on a business trip to Hiroshima when he was exposed to radiation from the nuclear bomb (3km from the epicentre).

On the following day he headed home on an evacuation train to be reunited with his wife and children. He arrived at Nagasaki station at midday on 8 August and received medical treatment. On 9 August he reported for work at his marine architecture firm and, while telling of the horrors he had witnessed in Hiroshima, became for the second time the victim of an atomic bomb.

Twice Bombed: the Legacy of Yamaguchi Tsutomu (2011) tells his story and recounts the hard fought campaign of his later years against nuclear weapons. Also being screened is Twice Bombed (2006) about Yamaguchi and six other people who had been exposed to radiation from both bomb blasts.

We are delighted to welcome the film’s producer, Hidetaka Inazuka, who spent time with Yamaguchi until his death in January 2010 and is determined to pass on his legacy to viewers.

でも、思わぬ指摘はCの夫、Dからだった。「おばあさん以外の登場人物、全く日本人に見えなかった。君たち日本人には、登場人物は日本人にみえるのかい？Both Satsuki and May could be seen as a French」。 そんなこと考えたこともなかったので、苦し紛れに「高度成長期以降、西洋に追いつけ追い越せというのが日本国内の気分だったろうから、ないものねだりの気分があったのかもしれない」と。 Dは納得していなかったので、切り口を変えてこう質問してみた。「例えば、君が仕事で日本や中国に行くとする。現地の人との親和を図るために、君の名前と全く関連のない日本風の名前や中国風の名前で呼ぶように依頼するかい？」。 その場の雰囲気を言葉で再現することはとても難しいけど、「外国に行って、その国にあった名前をあえて使う」という発想はできないようだった。こういう、言葉になりにくい意識の差って、本当に興味深い。

Henry Bloch knows a lot about taxes and a lot about wealth. He is the retired honorary chairman of H&R Block, a Kansas City-based tax services company, which he founded with his brother in 1955.Having amassed a fortune by helping Americans process their tax returns, the philanthropist – and registered Republican – believes the time has come for higher taxes on his richest fellow countrymen.

“It’s not going to hurt the wealthy to part with a little money,” Mr Bloch, 89, a navigator on B-17 bomber missions during the second world war, told the Financial Times this week. “This is a wonderful country and that’s the least they could do.”

Mr Bloch’s words highlight the intensity of the debate over the taxation of the highest-income Americans as the US struggles to find ways to reduce its long-term budget deficits.

On Monday, Warren Buffett, the billionaire investor, proclaimed that he too was in favour of raising more revenue from his cohorts. “While the poor and middle class fight for us in Afghanistan, and while most Americans struggle to make ends meet, we mega-rich continue to get our extraordinary tax breaks,” Mr Buffett wrote in The New York Times.

The call for higher taxes on the wealthy – which is shared by President Barack Obama and many congressional Democrats – appears to chime with the desire of most Americans. A CNN poll this month found 63 per cent of Americans favoured higher taxes on businesses and rich citizens to curb the soaring debt.

Even so, Republicans in Congress are showing few signs of backing down from their position that any tax increases would damage America’s weak economy – and that additional levies on the wealthy would hurt the generators of new employment at a time when it is desperately needed.

With some conservatives even decrying the efforts to impose higher taxes on the rich as “class warfare”, Republicans resisted any such measures in this month’s last-minute agreement to raise the US borrowing limit, which initially contained only reduced spending on government programmes.

The next front in the political battle will come when a bipartisan committee of 12 lawmakers has to decide – by November 23 – how to save a further $1,500bn from US budget deficits over the next decade. Republicans leaders have again indicated that they would not approve any deal containing tax rises. They also have some powerful backers among America’s wealthy elite.

Steve Forbes, the conservative publisher and flat-tax advocate, suggested Mr Buffett should simply give money to the government rather than have others shoulder higher tax burdens as well. “Treasury actually has a programme called ‘gifts to the US’ ... so, if he wants to send a couple of billion, I’m sure it would be gratefully received,” he told Thestreet.com.

However, most of the country’s richest have remained quiet in public on whether they should be taxed more, fearing the attention that might come from taking a position on either side. Opponents of higher taxes on the wealthy may not want to appear to be greedy. “No one wants to be the bad guy,” says David Logan, an economist at the Tax Foundation in Washington.

Mark Zuckerberg, the founder of Facebook, has seemed to embrace the idea of higher taxes. At a town hall meeting with Barack Obama in California this April, the president was pitching the White House deficit reduction plan, which includes higher taxes on the wealthy. “I’m cool with that,” Mr Zuckerberg said.

Also in April, Jamie Dimon, chief executive of JPMorgan Chase, told a conference: “I think those well off should pay a lion’s share, I have no problem with that.”

Last year, Washington state served as a microcosm of the national debate on the matter. Bill Gates Sr, father of Bill Gates Jr, the founder of Microsoft, led a campaign to approve a ballot initiative that would have imposed an additional levy on the wealthiest state residents.

Steve Ballmer, the chief executive of Microsoft, and Jeff Bezos, the chief executive of Amazon.com, donated money to efforts to defeat the measure. The “no” campaign won, perhaps in a sign that while Americans like the idea of taxing the rich, they fear that one day they too could be affected, either if they make more money or if it eventually leads to higher middle-class taxes.

But Frank Jernigan, a retired Google software engineer, is part of a group called the “patriotic millionaires for fiscal strength” that is advocating higher taxes on the rich and has been emboldened by Mr Buffett’s call. “Before Google, I lived my life like most Americans – barely making ends meet,” he says. Since then, Mr Jernigan says he has travelled the world, including Antarctica, and now resides in a luxury flat in San Francisco. “I don’t believe it would make one bit of difference” to pay higher taxes, he says.

I am writing to let you know that from Saturday 23 July until Tuesday 23 August inclusive, the Circle and District lines will be suspended between Edgware Road and High Street Kensington. This is due to track improvement and line upgrade work as part of the Tube upgrade plan.

This four week block closure has been planned to take place during a quieter period on the network and is being used instead of closing the stations for at least 20 weekends.

During these works:Please use alternative routes on the Bakerloo line for Paddington and Edgware Road, or the Central line for Notting Hill Gate and Bayswater (which is a short walk from Queensway station)Travel to High Street Kensington via the District line from Earl’s Court or the Circle line from Gloucester RoadBus route 27 will stop at, or near to, all affected stationsFor full details, including a pdf version of the leaflet about how your journey will be affected, please click here

Mental Health Policy: No health without mental healthMental health has become a core part of primary care in the UK. However, this central role has only recently been recognised through policy imperatives around the new mental health workforce and opportunities to re-examine how mental health services can be constructed and organised in primary care (Lester and Glasby, P.75, 2010).

In 2011, the UK government made their latest policy of mental health: No health without mental health. The core strategy of this demonstrates a set of “shared objectives to improve mental health outcomes for individuals and the population as a whole”. The six shared objectives are as follows:

More people will have good mental healthMore people with mental health problems will recoverMore people with mental health problems will have good physical healthMore people will have a positive experience of care and supportFewer people will suffer avoidable harmFewer people will experience stigma and discrimination(DoH, P. 6, 2011a)

According to the government, this new approach means a different approach to direction setting: developing strategies to achieve outcomes. Outcomes strategies focus on how practitioners on the front line can best be supported to deliver what matters to service users within an ethos that maintains dignity and respect (DoH, P. 11, 2011a). In line with the discussion of how the quality of mental health in primary care is improved, what changes the third object, More people with mental health problems will have good physical health, is expected to make is focused on.

As we have already explored, society has improved its awareness of how physical health affects mental health and vice versa. The government has also recognised the relationship as it presents some of the data; having a mental health problem increases the risk of physical ill health and depression increases the risk of mortality by 50% and doubles the risk of coronary heart disease in adults (DoH, P. 23, 2011a). Since about 90% of people with mental health problems are now managed entirely in primary care, ensuring that all people have access to effective primary health care is fundamental to improving the recognition and management of mental health problems (DoH, P. 33, 2011b).

In order to realise the government’s mental health strategy in primary care, improving the skills of primary care staff to enable them to recognise mental health problems earlier and to deliver appropriate treatments in a primary care setting is recommended by the National Institute of Health and Clinical Excellence (NICE) guidelines (DoH, PP.33-34, 2011b). In addition, different types of treatments, such as psychological therapies, in primary care are considered. Psychological therapies have been shown to improve outcomes for people of all ages with long-term physical conditions and mental health problems (DoH, P.61, 2011b). The expansion of psychological therapies has become a government priority, which should make psychological treatment more easily accessible in primary care (RCPSYCH and RCGP, P. 80, 2009). This clear understanding reflects an understanding that investing in mental health has a pay-off through physical health (CEP, P. 7, 2006).

While some GPs show their interest in developing a therapy capacity within their practice, the majority welcome the provision of a psychological treatment outside the practice, to which they can refer their patients (CEP, P. 9, 2006). Partly because of this situation, the government is accelerating a programme for people to have more access to psychological therapies in primary care. This plan is not new as NHS proposed a plan a decade ago that one thousand new graduate primary care mental health workers would be employed to help GPs manage and treat common mental health problems in all age groups (DoH, 2000, cited in Lester and Glasby, P.70, 2010).

The current programme is called the Improving Access to Psychological Therapies (IAPT) programme and aims to improve delivery of talking treatments to service users with mental health problems (RCPSYCH and RCGP, P. 7, 2009). The policies and details of the programme are;

The IAPT programme began in October 2007 when the government announced annual investment rising to ￡173m by 2010/11 to fund the roll-out of evidence-based psychological therapy services across England for people experiencing depression and anxiety disorders. The treatments offered are those approved by NICE for treating common mental health problems (NHS, P. 4, 2011b).

Investing around ￡400 million over the four years to 2014/15 enables every adult that requires it should have access to psychological therapies to treat depression (DoH, P. 2, 2011c).

The IAPT programme was created to offer patients a realistic and routine first-line treatment for depression and anxiety disorders, combined where appropriate with medication – which had traditionally often been the only treatment available. The programme was first targeted at people of working age. The economic case on which it was based showed that providing therapy could benefit not only the individual but also the nation, by helping people come off sick pay and benefits and stay in or return to work (DoH, P.5, 2011c).

It is based on a ratio of around 40 therapists serving a population of 250,000 (DoH, P. 13, 2011c).

In the next section, we will explain how IAPT works in primary care setting by introducing its two pilot sites, and then discuss what IAPT can further offer to the society.

How IAPT works in primary carePsychological, or ‘Talking’, therapy is a broad term covering a range of therapeutic approaches; they involve talking, questioning and listening to understand, manage and treat people’s problems. (NHS, P.19, 2007). A meta-analysis on psychological treatment finds that the psychological treatment of depression is effective in primary care patients. (Cuijpers et al, 2009). Thus, for the government, the Improving Access to Psychological Therapies (IAPT) programme is the main focus on the delivery of psychological therapies as part of a primary care setting.

The IAPT programme is at the heart of the Government’s drive to give greater access to, and choice of, talking therapies to those who would benefit from them and aims to implement NICE Guidance for people with depression. The government calculates that one in six working adults, who are current targets patients group, at any one time are suffering from clinical depression. In the first phase of the programme, two demonstration sites were established in Doncaster and Newham with funding to provide increased availability of cognitive-behaviour therapy-based (CBT) services to those in the community who need them. The services opened in late summer 2006 (CEP, 2008; NHS, P.4 & P.8, 2007).

By September 2007, the number of the patients who attended at least two sessions at both demonstration sites were 1654 at Doncaster and 249 at Newham. Both sites achieved good recovery rates (52%) for people who had depression and/or an anxiety disorder for more than 6 months. Another finding which can be highlighted is to offer patients a self-referral route to psychological therapies in primary care setting. GPs act as a “gate keeper” to specialist treatment services. However, concern that a GP only access system may disadvantage some individuals with mental health problems led the Newham Demonstration site to experiment with self-referral (Clark et al, 2009). Although the rate of the self-referral at Doncaster was less than 1 %, 21% of the patients at Newham accessed to the treatment were as self-referral (CEP, P. 30, 2008). In addition, providing a self-referral route appears to enable the service to access disabled individuals in the community who are not well served by existing GP only referral systems routes (CEP, P. 2, 2008).

Another notable result is that the two demonstration sites succeeded in helping people off sick pay and benefits so that they could stay in or return to work (DoH, P.5, 2011c). As a worked example, IAPT programme delivers efficiency and possible cash savings to local NHS of an estimated ￡1,060 on average for each additional person who recovers from depression or anxiety disorder (NHS, P. 2011a).

There are some points about how the IAPT will be developed for the society. Firstly, the current target patients group is working-age people with common mental illness, such as depression and anxiety disorder, but the government is to extend the programme for people with severe mental illness (DoH, P. 16, 2011c). In addition to this group, the government is also to include people with long-term physical health conditions, such as diabetes, cardiovascular disease or chronic obstructive pulmonary disease. The reason is that these people often have comorbid mental health conditions, but they are rarely referred for psychological interventions, despite good evidence that such management of mental health problems can reduce their need for GP appointments (DoH, P. 19, 2011c).

Secondly, the point of who delivers appropriate psychological therapies in primary care should carefully be assessed. In line with the efficiency of CBT, Haby et al (2006) raise an issue. Although they find CBT effective when offered by a psychologist, they are not clear whether psychiatrists, social workers, nurses, general practitioners or other professional groups can achieve the same efficacy. The British government say that the IAPT programme requires a total of 6,000 new IAPT High Intensity and Psychological Wellbeing Practitioners (PWP) workers (NHS, P.18, 2011b) for full coverage across the NHS. The training programme which they propose may better be updated in regular timing in order to keep the quality of the service to the society in primary care setting.

ConclusionAs demonstrated, both government and society have improved their understandings of how mental and physical health affect each other. Their awareness has also motivated primary care staff, for instance GPs, to provide appropriate treatment for mental illness as well as physical health problems. In addition, the government has keenly implemented the specific programmes to ensure the depressed can have more easy access to get psychological treatments in primary care setting. Needless to say, however, GPs are not trained as psychological therapists while the therapists in the programme cannot treat physical health problems. It is a vital point for us to know from whom we can have necessary treatment for either mental or physical health problems in a primary care setting.(4349 words)

DoH (2000): a plan for investment, a plan for reform cited from Mental Health Policy and Practice by Lester and Glasby (2010)

DoH (2011a): No health without mental health: A cross-government mental health outcomes strategy for people of all ages http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_124058.pdf

DoH (2011b): No health without mental health: Delivering better mental health outcomes for people of all ageshttp://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_124057.pdfDoH (2011c): Talking therapies: A four-year plan of actionhttp://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_123985.pdf

The Royal College of General Practitioners (2005): Mental Health and Primary Carehttp://www.rcgp.org.uk/PDF/clinspec_printed%20version%20mental%20health.pdf

The Royal College of Psychiatrists and Academy of Medical Royal Colleges (2010): No Health without Mental Health: the supporting evidencehttp://www.rcpsych.ac.uk/pdf/No%20Health%20without%20mental%20health%20the%20Evidence.pdf

The Royal College of Psychiatrists and the Royal College of General Practitioners (2009): The management of patients with physical and psychological problems in primary care: a practical guidehttp://www.rcpsych.ac.uk/files/pdfversion/cr152.pdf

Relating your discussion to recent and relevant policy, critically discuss the relationship between mental and physical health care and the way in which primary care services can respond to wider issues of mental illness in local populations.

As mental health issues become less stigmatised in our everyday life and society than before, our society shows a clearer understanding of what issues in mental illness we have to tackle to improve the quality of the treatment for those who suffer from mental disorders. Indeed, treatments for people with mental illness, such as depression and anxiety disorder, have been frequently updated by the government. Nonetheless, there are always continuing debates about the most suitable treatment for the depressed in primary care to be provided and how primary care staff should handle mental health problems while they also care for physical health problems. The aim of this report is, therefore, to discuss how mental health and physical health affect each other while to identify what impact depression, as one of the common mental health in the UK primary care, causes on our society. Then, with an evaluation of a recent mental health policy, we will assess the sort of treatment for the depressed is offered in primary care setting.

DepressionThe term ‘depression’ refers to a wide range of mental health problems characterised by low mood, loss of interest and enjoyment in ordinary things and experiences, and a range of associated emotional, cognitive, physical and behavioural symptoms (RCPSYCH and RCGP, P. 40, 2009). At a global level, depression is forecast to be the second most common cause of ‘disability’ by 2020 (Lester and Glasby, P.3, 2010), and depression is the most common mental health problem that doctors diagnose at primary care in the UK (RCPSYCH and RCGP, P.40, 2009). Accelerated by society’s improving attitudes towards mental illness (it is now less stigmatised and we talk about it more openly), the British government’s mental health policy has regularly been updated and developed. It seems that both society’s and people’s understandings of mental illness, such as depression and anxiety disorder, have become clearer and more compassionate than before.

In addition, since the National service framework for mental health: modern standard and service model was issued in 1999 (according to Lester and Glasby [P. 41, 2010] this is the first document in mental health to set a common agenda for local agencies), the quality of effective services for people with mental illness in the UK has been changing and has improved. For instance, better mental health care in primary care setting has been provided and consistent advice and help for people with mental health needs, including primary care services for “individuals with severe mental illness” (Lester and Glasby, P.41, 2010), has been provided and improved.

However, with our new more accurate understanding of mental illness, our society has also become aware of the serious impact caused by mental illness; our understanding of the seriousness of this impact has become clearer and the impact has increased. Although issued in 2006, The Depression Report warns that the total loss of output due to depression is “some ￡12 billion a year”. In other words, the more people suffer from depression, the less our society flourishes. Mental health effects both our well-being and our economic prosperity.

Furthermore, there are now more discussions focusing in particular on how depression affects physical health. One recent report shows that there is a high prevalence of major depression in people with chronic medical conditions with associated increases in the use of health services, lost productivity and functional disability (RCPSYCH and RCGP, P.42, 2009). Another report concludes: depression itself is a risk factor for physical illness and major depression doubles one’s lifetime risk of developing type 2 diabetes. Depression has also been proven to be a risk factor for the development of heart disease (RCPSYCH and AMRC, PP.9-10, 2010). The UK government is also aware of this point: depression is associated with a 50% increased mortality and doubles the risk of coronary heart disease. Having two or more long-term physical conditions increases the risk of depression seven-fold (DoH, PP. 33-34, 2011b). However, there is an opposing view on the relationship between physical health and mental health: people with chronic medical illness, compared to those without, have an increased risk of depression (RCPSYCH and AMRC, P.9, 2010). In the next sections, we will explore how mental and physical health affect each other and the impact they both exert on in primary care.

Mental health/ Physical healthApproximately one quarter of people with physical illness develop mental health problems as a consequence of the stress of their physical condition (RCPSYCH and AMRC, P. 9, 2010). Since illness is a threat to self, all illnesses have a “psychological impact” (RCPSYCH and RCGP, P.16, 2009) although its outcome can be different among people. If illness is a threat to self-identity, most individuals will be stressed by their symptoms and how they respond can influence the outcome either way. (RCPSYCH and RCGP, P.18, 2009). In other words, a person’s physical health status predicts their mental health and vice versa (Pilgrim, P.50, 2010). In the latest Mental Health policy, No health without mental health, the government clearly demonstrates an awareness that mental health and physical health affect each other: mental health problems such as depression are much more common in people with physical illness. Having both physical and mental health problems delays recovery from both (DoH, P. 23, 2011a).

Here are some figures which display the relationship between mental health and physical health.

Approximately 20% of patients have clinically significant depression at the time of diagnostic cardiac catheterisation.Depression increases the risk of developing coronary heart disease (CHD) and of adverse outcomes among those who already have CHD (RCPSYCH and AMRC, P.25, 2010).

Depression may be a risk factor for type 2 diabetes; in several prospective studies, depression predates the onset of type 2 diabetes by many years. Depression and depressive symptoms are associated with poorer glycaemic control, diabetes complications and increased risk of death (RCPSYCH and AMRC, P.26, 2010).Severity of diabetic symptoms is more strongly associated with depressed mood than with glycosylated haemoglobin levels (RCPSYCH and RCGP, P.43, 2009).

These data support the government’s view that both the development of mental health problems and the results are associated with poorer physical health (DoH, P. 9, 2011b).

As discussed above, the awareness of the important relationship between mental and physical health seems to have strengthened in primary care setting. In reality, however, there are still some discrepancies in the clinical setting. According to the joint report issued by two health professionals institutions, most people with chronic illness now receive a regular review of their physical condition by their GP, but psychological status is often neglected despite the fact that all patients with chronic illness should receive a regular review of their physical, psychological, social and spiritual needs (RCPSYCH and RCGP, P.34, 2009).

If we wish to narrow the gap, there are a couple of situations to be considered. For instance, although depression is common in physical illness, particularly in chronic illnesses, mental health services are “separated from physical health services with separate commissioning processes, targets and service boundaries” (RCPSYCH and RCGP, P.7, 2009). In addition, primary care is charged with providing care for common mental health problems and contributing to health promotion, but there is a “lack of clarity about who should lead on the care of those” (RCPSYCH and AMRC, P.17, 2010) with mental health problems.

Another report finds that when a chronic physical disease is found to be present, there is the risk that attention will shift to this disease and the depression may be overlooked (RCPSYCH and AMRC, P.11, 2010). This may be due to prioritisation of physical health problems, perceived lack of expertise among GPs, or reluctance by patients to engage in mental health services. For instance, this causes a situation that the majority of depressed CHD patients do not receive adequate treatment for their depression (RCPSYCH and AMRC, P.26, 2010).

In order to improve the situation that both mental health and physical health are treated as a whole in primary care setting, a criticism which also seems to be a helpful opinion should be considered:

Many mental health care practitioners have little training in how to manage physical care, the rates of physical assessments of those under care are poor and the monitoring of physical health and health education is generally unsatisfactory. This situation results from the fact that healthcare services are often fragmented and un-coordinated, with both clinicians and those under care, unaware of available and appropriate resources (Running On Empty, P.11, 2005).

It is important for health care professionals to understand how mental health can affect overall physical health and vice versa (Running On Empty, P. 19, 2005).

Primary CareBefore we explore the government recent mental health policy, it is useful to understand what role the UK primary care plays in the society. By summarising their description from Mental Health Policy and Practice (Lester and Glasby, 2010), primary care in the UK generally offers rapid access for routine and crisis care in a low-stigma setting. A key strength of the primary care is open access where the patient is seen as part of a complex network of family, friends, work and social life. Because different patients display and talk about their own unique problems, primary care has developed sophisticated ways of working with the uncertainty and complexity of its environment. The front line staff of primary care services are GPs, practice nurses, district nurses, health visitors, practice managers, administrative staff (Lester and Glasby, PP.55-75, 2010).

Recently, primary care has been asked to play another role that provides and increasingly commissions good quality mental health services since most people with mental health issue are seen and treated within this setting (Lester and Glasby, P.13-14, 2010). Primary care in commissioning services has come to meet the needs of local people who are experiencing the common mental health problems of depression and anxiety disorders (NHS, P.1, 2011a).

The need to address patients’ psychological welfare has clearly been recognised in primary care and many people now present to GPs with physical symptoms that often have an underlying psychological component. (RCPSYCH and RCGP, P.6, 2009). As well as their physical needs, primary care has been important for people with mental health problems. There are two reasons; first, over 90% of them will be in contact with their GP or other primary health care worker. Second, only 10% of such patients are referred on to specialist mental health services. Consequently, most people with mental health problems only receive a primary care response (Pilgrim, P.77, 2010).

The need to increase the recognition and treatment of depression in the community through the development of guidelines for depression (Lester and Glasby, P.65, 2010) has been one of the main issues which the UK primary care has been tackling. As a result, at present 2¾ million patients come to GP surgeries each year with depression or anxiety (CEP, P.10, 2006). In the average GP surgery in the UK around one in four people consulting a doctor will be significantly distressed psychologically as defined by validated instrumental measures and systematic clinical assessment (RCPSYCH and RCGP, P.18, 2009). Another report shows that 90 per cent of people with mental health problems are cared for entirely in primary care (RCPSYCH and AMRC, P.17, 2010).

As secondary mental health services focus more and more on severe mental illness, primary care mental health teams and GPs are faced not only with service users with mild or acute psychological issues, but also those with long-standing problems and chronic difficulties. Primary care services are best placed to provide a comprehensive and integrated service for individuals with both physical and mental health problems, providing there is sufficient skill base among the staff and resources to manage these kinds of problems (RCPSYCH and RCGP, P. 76, 2009).

Despite the above, some new issues have recently emerged. First, primary care is the gateway to specialist services but because of limited capacity in the latter, non-specialist staff are often left to manage complex cases (Pilgrim, P.78, 2010). Second, healthcare professionals working in primary care are well placed to understand the relationship between physical health problems and mental health (DoH, P.33, 2011b), but mental health problems are particularly hard to detect when there is an overlap of symptoms (RCPSYCH and AMRC, P.11, 2010) unless the staff are provided training to improve their understanding of the relationship between mental health and physical health. In addition, clinical barriers, such as short appointment times, a lack of knowledge about depression and treatment, or a lack of time to talk to the patient about these issues can also prevent detection of mental illness (RCPSYCH and AMRC, P.11, 2010).Health professionals express their further concern how mental health problems are not satisfyingly treated in primary care setting;

Some healthcare professionals may not think to enquire about psychological symptoms, or may feel uncomfortable doing so. Even if the symptoms of depression are discussed, practitioners might regard depression and anxiety as understandable reactions to being physically unwell. As such, the patient’s symptoms are normalised and the practitioner might not realise the mental health problem could be treatable (RCPSYCH and AMRC, P.11, 2010).

What GPs do for the depressed in primary careIn the recent British mental health policy context, primary care has been charged with improving services to people with mental health problems in two ways. First, primary care practitioners are now expected to ensure consistent advice and help to people with mental health problems. Second, all patients should have their mental health needs assessed (Pilgrim, P.78, 2010). Therefore, GPs are now seen to play a key role in helping patients to cope with physical illness and “facilitating a natural psychological adjustment” (RCPSYCH and AMRC, P.17, 2010). The majority of people with serious mental illness and with common mental health problems are now registered with a GP while only approximately 10 per cent of people with a mental health are seen by secondary care mental health specialists (Lester and Glasby, P.65, 2010). Mental health issues are the second most common reason for consultations in primary care. GPs in England spend on average approximately 30 per cent of their time on mental health problems (Lester and Glasby, P.65, 2010).

Although they are responsible for most people with mental health problems within primary setting (Pilgrim, P.78, 2010), GPs are criticised for their lack of mental health knowledge and the low achievement in treating depression. For GPs, consultations with patients who have health problems related to anxiety and depression frequently pose a challenge for which there are two main reasons. Firstly, limited time is available: patients with these issues take up more time during a consultation and attend more frequently than other patients, often with vague reasons for their visit. Secondly, the implementation of treatment is often complicated (Schreuders et al, 2007).

This situation echoes a result of a survey. According to Lester and Glasby (P.67, 2010), only one third of GPs have had mental health training in the last five years, while 10 per cent have expressed concerns about their training or skills needs in mental health. Hence, GPs are, in general, less likely to make a diagnosis of depression when people present with physical symptoms (RCPSYCH and RCGP, P. 44, 2009).

In addition, GPs may need to be careful not to over-diagnose depression. In UK general practice, particularly since the advent of once-daily antidepressant medication, there is a growing tendency to use a diagnosis of depression as an apparently handy means of finding one’s way out of consultations that doctors find difficult to resolve (RCPSYCH and RCGP, P. 45, 2009). GPs vary a great deal in their likelihood of making a diagnosis of depression. This is partly related to the way they approach mental health as a clinical problem. In other words, GPs are more likely to make a diagnosis when they feel comfortable about treating depression (RCPSYCH and RCGP, P.43, 2009).

Because poor primary mental health care has the potential to do harm (RCGP, P.5, 2005), it is vital that GPs increase their ability to identify and diagnose cases of depression and anxiety (CEP, P. 9, 2006). GPs are recommended to ask their patients routinely about their mood, particularly those with serious or chronic illness. Many individuals in primary care present with physical symptoms for which it is difficult to establish an underlying cause. Some patients are reluctant to talk about their mental health symptoms and, even within lower-stigma setting of primary care, are worried about the effects of divulging symptoms of mental illness (Lester and Glasby, P.67, 2010). It is important that GPs adopt a balanced perspective and consider physical, psychological and social factors and their interaction (RCPSYCH and RCGP, P. 31, 2009).

The core of a GP’s role is to help patients make sense of often paradoxical symptoms in the context of their whole life story. Listening and helping patients to reflect can often be more relevant than having correct answers. When the system is welcoming and the clinicians have both the skills and time available, general practice is ideally placed to work with patients with mental health problems; (RCGP, P.5, 2005). If GPs improve the quality of their attitudes towards and knowledge about mental health issues, GPs can enable all patients to “help themselves contribute to society, and its understanding of mental health” (RCGP, P.9, 2005) by using mental health in primary care setting. In the next section, what the latest mental health policy directed by the UK government proposes to improve the quality of the care for the depressed provided in primary care setting will be discussed.

「日本公演の話を聞いていると、放射線への恐怖がないように感じるのですが？ It seems that you are not afraid of radiation.」Yes, I am, yes, I am. もちろん、私は放射線を恐れています。恐れていますが、私は日本に行きたいのです。もしかしたら危険が伴うことなのかもしれません。でも、それと向き合わなければ。私は、私自身が勇敢だなんて思っていませんし、（放射線の危険性に）戸惑ってもいます。でも、最悪なことは、その状況から目をそらしてしまうこと。 ええ、放射線は怖いです。でも、日本の皆さんのために、私は日本に行きます。だって、人々はそこで暮らしているのですから。

Sylvie has called this evening of work 6000 miles away as she was working on Forsythe's piece, REARRAY, when the tragic events in Japan happened earlier this year. Because the people of that country are very close to her heart, the proceeds from Thursday night's special Hope for Japan performance will be donated to the Japan Tsunami Appeal, managed by the British Red Cross.（プログラムの冒頭、スポルディング氏の言葉の一部）

The London Underground map, created by Harry Beck in 1931, was an example of great information design, but is now outdated. So says a British designer who is proposing a more geographically accurate version of the iconic map.

Mark Noad explained that when Beck’s original map was in use, there were only seven lines on the Underground so “the compromises Beck made on geographical accuracy did not matter greatly”. Today, there are more than twice that number of lines in operation, exacerbating the inaccuracies.

“They form the basis for a major criticism of the diagram, that it bears little or no relation to London at street level,” Noad wrote on the project website. This distorts the actual physical locations of some stations, leading to confusion when selecting a route to take, or whether it is quicker to walk between stations.

One major change Noad attempted was to change Beck’s 45-degree angles into 30- and 60-degree ones; it “shortens the extremities of the lines to make it more compact”, Noad explained.

The designer is planning to launch a fully-functional site of the redesigned map, including “loads of info including parks and attractions”, he tweeted. An app version of the redesign is also in the works.